DeeJaye
1st Consultation Visit
May 21, 2009
My first visit with Dr. Beltre & his staff was interesting. I learned a lot though & have plenty to contemplate.
First, he's a really nice man. I found him down to earth & kind, as well as very honest & open. I felt comfortable with him & plan to use him to do my hernia surgery. He checked out my abdomen (where my hernia is) and ordered a CT scan to get a better look. He's unsure if it's a small hernia or a mass of some sort. So the CT scan will solve that mystery. He did tell me that I could not get the hernia done along with any other type of surgery, as risk of infection is too great. So the hernia surgery comes first. I hope to have that in early July sometime.
As for the VSG...He said I was a good candidate for it & that the results of his previous surgeries have been wonderful. I am at the very low end of surgery requirements though, since my BMI is 40 and most are 50+. In that sense, he made me feel very "small" - LOL But I do meet the medical requirements because I have Type II diabetes as a secondary condition.
However, we went over my insurance paperwork & CIGNA does not cover VSG. He said he would be glad to make a case for me & submit paperwork, talk to CIGNA, etc - but it doesn't look very positive. Sighs. I was afraid of that. Add to that the fact that I don't even know if my general doctor would be willing to write me a letter of necessity (required by CIGNA) for the surgery as I am again on the low end of their requirements. My general doctor weighs all of 100lbs herself & seems to think I can easily lose the weight on my own if I try. She doesn't "get" what it's like to be big in any sense whatsoever...
To top it all off, one of CIGNA's requirements for approval is a 6 month consecutive diet program supervised by a doctor. That doctor cannot be your regular doctor, but must be an entirely separate doctor that you see once a month for 6 months. Apparently they put you on some sort of pill (Meridia, Xenical, Phentermine, etc) along with a low calorie diet & exercise program to monitor your progress.
Now, I find this funny, because right now my BMI is 40. If my BMI gets below 40, I won't get approved. And after 6 months of any diet program, of course I will lose some weight...thus, once I do, I can't get the surgery anyway. Ironic eh?
Add to that the fact that CIGNA will most likely not approve a VSG at the end of this road anyway, and I end up in a quandary....
I am sitting here adding up the costs just to get approved, along with the requirements:
1. A 6 month diet program at one visit a month. Each visit is a $30 copay = $180
2. At least 2+ visits with my general doctor, one for lab work & one to get a letter of necessity for surgery = $60+
3. Several visits with a dietitian as required by CIGNA, located clear across town from my house = $30 each visit (no idea how many visits I will need for this to be complete)
4. A psychological exam to ensure I am mentally sound & able to have surgery = $30
We are talking about spending possibly $300+ out of pocket to jump through hoops that may end up with me standing at the starting line anyway. Hmmmm.
For now, I have decided to see a dietitian close to my home about this 6 month monitored diet program & go from there. My theory is that hey, if I lose weight on it and it works, then I will keep on that & skip having WLS all together. And if I don't lose weight, at least I will have met that 1 requirement & gotten that out of the way. Meanwhile, I am going to get my CT scan done & schedule surgery to have my hernia fixed. I want to get healed from that anyway.
So that's where I am at now. At least I have more information than I started with. And I am even more annoyed with insurance companies in general. But they have us cornered, as this surgery costs 17k out of pocket if I have no coverage. Yikes!
In regards to Dr. Beltre's staff. They did not offer a lot of information to me up front. The folder they gave me regarding surgery costs & requirements was clearly lacking, as they did not indicate additional requirements by various insurance companies. I had to ask about the 6 month diet program requirement myself. And honestly, if I had no read about it here on obesityhelp.com, I wouldn't have even known about it.
In other words, you MUST do your own research, as staff will not direct you or provide the complete information you need.
They pretty much expect you to be an expert on everything, which really is the wrong way to go about running a business if you ask me...
Before I left, I asked them a lot of questions. I felt like I had to "hold their hand" so to speak in order to guide them to help me & give me the information I need for this surgery. It was incredibly backwards & I can't help but wonder if surgeons realize that it's in their best interest to provide all the information up front & be helpful to their patients. I sure would have hated to fulfill all the other requirements (dietitian, psychological exam, doctor letter of necessity, etc) thinking I was done & ready to submit only to find out I need to wait another 6+ months for the supervised diet program!
And lets face it, as a doctor, your staff is easily 50% of your business isn't it?
0 comments
First, he's a really nice man. I found him down to earth & kind, as well as very honest & open. I felt comfortable with him & plan to use him to do my hernia surgery. He checked out my abdomen (where my hernia is) and ordered a CT scan to get a better look. He's unsure if it's a small hernia or a mass of some sort. So the CT scan will solve that mystery. He did tell me that I could not get the hernia done along with any other type of surgery, as risk of infection is too great. So the hernia surgery comes first. I hope to have that in early July sometime.
As for the VSG...He said I was a good candidate for it & that the results of his previous surgeries have been wonderful. I am at the very low end of surgery requirements though, since my BMI is 40 and most are 50+. In that sense, he made me feel very "small" - LOL But I do meet the medical requirements because I have Type II diabetes as a secondary condition.
However, we went over my insurance paperwork & CIGNA does not cover VSG. He said he would be glad to make a case for me & submit paperwork, talk to CIGNA, etc - but it doesn't look very positive. Sighs. I was afraid of that. Add to that the fact that I don't even know if my general doctor would be willing to write me a letter of necessity (required by CIGNA) for the surgery as I am again on the low end of their requirements. My general doctor weighs all of 100lbs herself & seems to think I can easily lose the weight on my own if I try. She doesn't "get" what it's like to be big in any sense whatsoever...
To top it all off, one of CIGNA's requirements for approval is a 6 month consecutive diet program supervised by a doctor. That doctor cannot be your regular doctor, but must be an entirely separate doctor that you see once a month for 6 months. Apparently they put you on some sort of pill (Meridia, Xenical, Phentermine, etc) along with a low calorie diet & exercise program to monitor your progress.
Now, I find this funny, because right now my BMI is 40. If my BMI gets below 40, I won't get approved. And after 6 months of any diet program, of course I will lose some weight...thus, once I do, I can't get the surgery anyway. Ironic eh?
Add to that the fact that CIGNA will most likely not approve a VSG at the end of this road anyway, and I end up in a quandary....
I am sitting here adding up the costs just to get approved, along with the requirements:
1. A 6 month diet program at one visit a month. Each visit is a $30 copay = $180
2. At least 2+ visits with my general doctor, one for lab work & one to get a letter of necessity for surgery = $60+
3. Several visits with a dietitian as required by CIGNA, located clear across town from my house = $30 each visit (no idea how many visits I will need for this to be complete)
4. A psychological exam to ensure I am mentally sound & able to have surgery = $30
We are talking about spending possibly $300+ out of pocket to jump through hoops that may end up with me standing at the starting line anyway. Hmmmm.
For now, I have decided to see a dietitian close to my home about this 6 month monitored diet program & go from there. My theory is that hey, if I lose weight on it and it works, then I will keep on that & skip having WLS all together. And if I don't lose weight, at least I will have met that 1 requirement & gotten that out of the way. Meanwhile, I am going to get my CT scan done & schedule surgery to have my hernia fixed. I want to get healed from that anyway.
So that's where I am at now. At least I have more information than I started with. And I am even more annoyed with insurance companies in general. But they have us cornered, as this surgery costs 17k out of pocket if I have no coverage. Yikes!
In regards to Dr. Beltre's staff. They did not offer a lot of information to me up front. The folder they gave me regarding surgery costs & requirements was clearly lacking, as they did not indicate additional requirements by various insurance companies. I had to ask about the 6 month diet program requirement myself. And honestly, if I had no read about it here on obesityhelp.com, I wouldn't have even known about it.
In other words, you MUST do your own research, as staff will not direct you or provide the complete information you need.
They pretty much expect you to be an expert on everything, which really is the wrong way to go about running a business if you ask me...
Before I left, I asked them a lot of questions. I felt like I had to "hold their hand" so to speak in order to guide them to help me & give me the information I need for this surgery. It was incredibly backwards & I can't help but wonder if surgeons realize that it's in their best interest to provide all the information up front & be helpful to their patients. I sure would have hated to fulfill all the other requirements (dietitian, psychological exam, doctor letter of necessity, etc) thinking I was done & ready to submit only to find out I need to wait another 6+ months for the supervised diet program!
And lets face it, as a doctor, your staff is easily 50% of your business isn't it?
Getting some info
May 15, 2009
Well...I have decided schedule an consultation with Dr. Wiljon W. Beltre in Altamonte Springs, FL to discuss VSG surgery. I also have a surgical hernia that I need removed & I want to consult with him on that also. My hope is to have both done at the same time, if possible.
I have CIGNA PPO & as far as I can tell, I meet their requirements. I am in their required BMI range, have a secondary medical condition (type II diabetes) and am in otherwise good health. I do not have high cholesterol or blood pressure, nor any other issues that some may have going into this surgery. My hope is to lose close to 100lbs, putting me around 130-140. At 5'4", that is an ideal weight for my body structure (medium build)
My consultation is Thursday morning, so wish me luck!!
I'll report back after my initial visit
I have CIGNA PPO & as far as I can tell, I meet their requirements. I am in their required BMI range, have a secondary medical condition (type II diabetes) and am in otherwise good health. I do not have high cholesterol or blood pressure, nor any other issues that some may have going into this surgery. My hope is to lose close to 100lbs, putting me around 130-140. At 5'4", that is an ideal weight for my body structure (medium build)
My consultation is Thursday morning, so wish me luck!!
I'll report back after my initial visit
About Me
Altamonte Springs, FL
Location
40.3
BMI
Surgery
01/24/2011
Surgery Date
May 15, 2009
Member Since
